CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Wellspan Ephrata Community Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $164
Cash Discount Price: $208
vs. Medicare Baseline: 5.01x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Wellspan Ephrata Community Hospital is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $208. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.01x the Medicare baseline. Located in 169 Martin Avenue, Ephrata, PA.

Cash / Self-Pay

$208

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $208 (636%)

Insurance Median: $164 (501%)

Cash: $208 (636% of Medicare)

Ins. Median: $164 (501% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 501% of the Medicare baseline (a markup of 401%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$31 - $208	95%
Medicare (plans)	$31 - $47	95%
Highmark	$48 - $142	147%
Medicaid / KanCare	$50 - $81	153%
Blue_Cross	$114 - $173	348%
Cigna	$153 - $172	467%
Wellspan_Capital_Blue_Cross	$161 - $172	492%
Geisinger	$164 - $175	501%
Independence_Blue_Cross	$164 - $175	501%
Tower Health	$164 - $184	501%
Upmc	$164 - $215	501%
Phc	$176 - $191	538%
First_Health_Network	$214 - $229	654%
United_Healthcare	$238 - $254	727%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $208.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Wellspan Ephrata Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97112.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.